The recent National Audit office report on Hospital Acquired Infections drew attention to poor hygiene in hospitals, and one radio report even echoed my own feelings that healthcare has a long way to go before it reaches the standards demanded in food production.
The suggestion that up to 100,000 patients succumb to hospital acquired infections and that as many as 5000 die in this way is, from any standpoint, alarming. Even the finding that patients have a one-in-nine chance of being infected causes considerable concern.
The thrust of the report seems to be that there is an increasing need to improve infection control regimes and the report emphasises a need for greater awareness of personal hygiene and in particular, effective handwashing. In controlling infection, there is a need to control personnel in operational and service areas. Such control could involve, monitoring and validating both new and existing contracts for those providing services to a hospital or health trust, including, of course, laundry operators and contractors.
In my article on thermal disinfection (LCN October 1999), I pointed out that almost any laundry undertaking hospital contract work, simply would not be allowed to produce work for the food processing sector, a sad reflection on the laundry industry.
Rigorous policing
The provisions for control and monitoring performance contained in current NHS guidelines, NHSG (95) 18 issued in 1995, do not compare with those laid down for the food industry. In the food sector the customer can and does rigorously police the supplier’s operation and performance and there are several cases where contracts have been terminated immediately for non-conformance. In contrast, my consultancy has seen several examples of hospital contracts being operated without any form of monitoring, not even a cursory visit.
The laundry industry can and usually does respond to challenges. Operators undertaking contracts for the food industry have invested heavily in appropriate plant and procedures, quality control and validation and staff training. However, the cost of such controls has been built into the price charged to the customer.
It is suggested that healthcare launderers may have to build in improvements such as higher temperatures, longer process times, barrier operations, clean-room packing, all of which are worthwhile and desirable. Regrettably, with hospital based contracts, the deciding factor for a successful tender is usually the bottom-line price.
If the laundry industry is required to meet higher standards for hospital contracts the bottom-line price will need a considerable increase. As we know, the NHS fights a losing battle against service demands such as the rising costs of drugs, new high-tech equipment and higher salaries and recruitment. But, how long will it be before the Health Service also faces horrendous costs arising from litigation by patients, or their families, where it can be shown that the infection they contracted within hospital was probably due to deficiencies in the treatment, environment or facilities management for which the hospital or trust was responsible and accountable?
Damages
Compared with the cost of legal action for damages, loss or death, the increase in charging needed to allow laundries to invest in order to meet stricter hygiene standards seems minimal. In a typical trust contract of 60,000 pieces of laundry per week and adding 5p per piece might cause some Health Service “bean counters” to draw a sharp intake of breath. However, in real terms, a 5p increase, around 20% on many current contracts, would only increase the overall cost to the trust by around £160,000 per year, and again this seems trivial when compared both with the overall budget and the likely cost of just one claim for loss or damage.
I would suggest that hospital laundry contractors would be happy to meet requirements for tighter control and improved hygiene, contract and process monitoring and validation, if they were to receive a 20% increase on current pricing.
Risk Assessment
Of course the question of whether the NHS can bear such extra costs, is also one of risk assessment. In the case of any action, the courts would have to decide whether the infection had been picked up from a laundry service or elsewhere. However, it is known that infections tracked to a hospital laundry have been responsible for patient deaths in the UK. Simply, a laundry service is a possible carrier for infection and, as a provider of a professional service the industry should ensure that its service is truly above reproach, without risk to the customer, and regarded as a safe and hygienic service by all users. The sector should also ensure that such a service is delivered at an economic price level and not at some of the nonsensical prices seen and contracted for in recent years and used simply to get the business.
It is time for a reappraisal and perhaps the National Audit Office Report will provide the kick-start that both the NHS and the laundry industry needs.
